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Jean-Philippe Nordmann, Jean François Rouland, Jullien Daniel Guelfi, Jean-Paul Renard, Philippe Denis, Eric Sellem, Christophe Baudouin, Sylvie Troy, Madina Estephan, Alain Bron; Patient/Physician "Bond" (Relationship) In The Management Of Glaucoma. Invest. Ophthalmol. Vis. Sci. 2011;52(14):5062.
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Treatment success in Glaucoma and Ocular Hypertension (OHT) depends on the patients’ adherence.Concept of "therapeutic alliance" (TA) known in psychiatry permits better understanding of the multidimensional aspect of the patient -physician relationship. So-called "bond" between physician and his patients reflects mutual trust and acceptance and helps to establish an interactive agreement on the "tasks" and the "goals" of treatment. Present study named "GRAAL - Glaucoma Research on Adhesion and Alliance" was to evaluate TA and its’ 3 components between ophthalmologists and patients with Glaucoma or OHT.
Multicenter, non-interventional study was conducted in France in 2010, 178 general ophthalmologists included 748 patients. To evaluate TA we used validated French translation of the Working Alliance Inventory (WAI) - physician and patient versions of 36 items self-administered questionnaires. Each dimension/component of TA - "bond", "task, "goals" corresponded to 12 items. Items in the WAI Q scored from 1 (low) to 7 (high) according to the degree of agreement or disagreement.
Participated physicians had mainly (64%) a private practice and 24 years of professional experience in overage. 491 pairs of WAI Qs were completed and analysed. From 491 patients 22% had OHT and 78% had glaucoma with mean time of disease onset 8,2 years, and median duration of follow up of 8 years. Mean scores for three subscales each reflecting: "Bond" were 73/75, "Goals" were 72 /73, "Tasks" were 72/76 respectively for physician and patients. Mean WAI total scores were 217 for physicians and 224 for patients with 0,208 (<0,001) Spearman correlation. All three compounds of TA revealed a strong relationship between general ophthalmologist and glaucoma patients.
Patients/physician relationship could be considered as a key factor to improve patients’ adherence to treatment in chronic diseases. Several studies in psychiatry, diabetes shown importance of construction and development of Therapeutic Alliance in order to achieve better clinical outcomes. This is the first study to evaluate the concept of the therapeutic alliance in the glaucoma management.
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